Aldobyany Ahmad, Touman Abdelfattah, Ghaleb Nabil, Alsaggaf Rajaa, Murtaza Noureen, Hamada Adel, Alknawy Moataz, Albanna Amr S, Alqurashi Eid
Medicine Department, King Abdullah Medical City, Mecca, Saudi Arabia.
King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
Front Med (Lausanne). 2020 Dec 7;7:605689. doi: 10.3389/fmed.2020.605689. eCollection 2020.
COVID-19 clinical presentation is usually non-specific and includes commonly encountered symptoms like fever, cough, nausea, and vomiting. It has been reported that COVID-19 patients can potentially transmit the disease to others before developing symptoms. Thus, extensive surveillance and screening of individuals at risk of the disease is required to limit SARS-COV-2 spread. The COVID-19 respiratory triage score has been used for patient screening. We aimed to determine its diagnostic performance characteristics, which have not been adequately studied before. This is a retrospective observational study involving all patients screened for COVID-19 at a tertiary care facility. Patients were tested using nasopharyngeal swab for SARS-COV-2 PCR. The Saudi CDC COVID-19 respiratory triage score was measured for all subjects. The sensitivity, specificity, positive predictive value, and negative predicted value of COVID-19 respiratory triage score were measured with reference to SARS-COV-2 PCR test. Multivariate regression analysis was done to identify factors that can predict a positive SARS-COV-2 PCR test. A total of 1,435 subjects were included. The COVID-19 respiratory triage score provided a marginal diagnostic performance with a receiver-operating characteristics (ROC) area under the curve value of 0.60 (95% CI: 0.57-0.64). A triage score of 5 provided the best cut-off value for the combined sensitivity and specificity. Clinical characteristics that independently predicted positive COVID-19 PCR test include male sex (adjusted OR: 1.47; = 0.034), healthcare workers and their family members (adjusted OR: 1.99; 95%; = 0.016), fever (adjusted OR: 2.98; < 0.001), and moderate disease severity (adjusted OR: 5; < 0.001). The current COVID-19 respiratory triage score has marginal diagnostic performance characteristics. Its performance can improve by including additional predictors to the respiratory symptoms in order to avoid missing COVID-19 patients with atypical presentation and to limit unnecessary SARS-COV-2 PCR testing.
新冠病毒病（COVID-19）的临床表现通常不具有特异性，包括发热、咳嗽、恶心和呕吐等常见症状。据报道，COVID-19患者在出现症状之前就有可能将疾病传播给他人。因此，需要对有患病风险的个体进行广泛监测和筛查，以限制严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的传播。COVID-19呼吸分诊评分已用于患者筛查。我们旨在确定其诊断性能特征，此前尚未对其进行充分研究。这是一项回顾性观察研究，涉及在一家三级医疗机构接受COVID-19筛查的所有患者。使用鼻咽拭子对患者进行SARS-CoV-2聚合酶链反应（PCR）检测。为所有受试者测量沙特疾病预防控制中心（Saudi CDC）的COVID-19呼吸分诊评分。参照SARS-CoV-2 PCR检测结果，测量COVID-19呼吸分诊评分的敏感性、特异性、阳性预测值和阴性预测值。进行多变量回归分析，以确定可预测SARS-CoV-2 PCR检测呈阳性的因素。共纳入1435名受试者。COVID-19呼吸分诊评分的诊断性能一般，曲线下面积（AUC）值为0.60（95%置信区间：0.57 - 0.64）。分诊评分为5时，综合敏感性和特异性的最佳截断值。独立预测COVID-19 PCR检测呈阳性的临床特征包括男性（调整后的比值比：1.47；P = 0.034）、医护人员及其家属（调整后的比值比：1.99；95%置信区间；P = 0.016）、发热（调整后的比值比：2.98；P < 0.001）和中度疾病严重程度（调整后的比值比：5；P < 0.001）。当前的COVID-19呼吸分诊评分的诊断性能特征一般。通过将其他预测因素纳入呼吸道症状，其性能可以得到改善，以避免漏诊非典型表现的COVID-19患者，并限制不必要的SARS-CoV-2 PCR检测。
